The Ellen Kennedy Living Center

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

S0155 Issued in IA

Legal business name

THE ELLEN KENNEDY LIVING CENTER

Practice address

1177 7TH St SW
Ste #1
Dyersville, IA 52040-2513

Phone

(563) 875-6323

Fax

(563) 875-6268

NPI assigned

May 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kari Anne Wittmeyer

Title

Director

Phone

(563) 875-6323

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184837593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 7TH ST SW",
            "address_2": "STE #1",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "520402513",
            "telephone_number": "563-875-6323",
            "fax_number": "563-875-6268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1177 7TH ST SW",
            "address_2": "STE #1",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "520402513",
            "telephone_number": "563-875-6323",
            "fax_number": "563-875-6268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE ELLEN KENNEDY LIVING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WITTMEYER",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "563-875-6323",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IA",
            "license": "S0155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0282384",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.